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Data-driven care manager outreach improves pregnancy outcomes

    About HPSJ: Not-for-profit, managed care plan serving 350K Medi-Cal beneficiaries

    Some pregnant moms are at higher risk of complications, which can mean unnecessary c-sections, longer hospital stays for moms, and premature babies. 1 in 10 babies are born premature – and not only do most preemies need intensive care to survive, but also they are more likely to have long term health problems.

    The good news is that if providers can find and engage high-risk moms in care management early in their pregnancies, they can significantly increase the chances of full-term, healthy babies. The bad news is that finding these moms early enough to improve outcomes can be a challenge.

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    How the Health Plan of San Joaquin has been finding high risk moms earlier in their pregnancies, and enrolling them in care management programs.

    HPSJ saw the opportunity to improve birth outcomes

    The Lead Case Manager at the Health Plan of San Joaquin wanted to better manage high-risk pregnancies to keep babies healthy, prevent moms from enduring the unnecessary risk of preventable c-sections, and shorten recovery times. Many HPSJ members lack sufficient postpartum support and access to cars for follow up care, so improved outcomes would meaningfully impact their birth experiences. And keeping moms and babies healthier would also enable HSPJ to redirect its resources to higher need patients.

    The Lead Case Manager joined the Advisory Board’s high-risk pregnancy collaborative and worked with other health plans to learn about best practices, develop strategies, work through obstacles, and hold each other accountable for progress. He developed a new algorithm that integrated new data from physician forms and prescriptions, and updated the algorithm more frequently to identify patients to target for care management enrollment. HPSJ hired a nurse to focus on caring for just high-risk moms, and armed her with outreach strategies, scripts and tools for engaging moms.

    Check out this article

    HPSJ isn’t the only health plan focused on high-risk pregnancies. Health Plan Partners saved $1.5M in 3 months by identifying high-risk pregnancies early.

    The moms and babies of HPSJ are spending more quality time together

    Within 2 months of starting, the dedicated nurse had a full case load. She identifies over 38% more potential high risk pregnancies per month, finds these moms an average of 2 weeks earlier, and has been successfully enrolling participants in tailored care management programs. She connects with some moms in-person throughout their pregnancies, and she just sends along relevant information at critical junctures to other moms.

    The impact: HSPJ is seeing fewer c-sections and fewer premature babies, and moms and newborns are spending more quality time together. Just one way that HPSJ is improving the health of San Joaquin and Stanislaus Counties.

    Did you know?

    • A full term baby averages 2 days in the hospital, but a premature baby stays an average of 15 days in the hospital.
    • A full term baby averages 14 outpatient visits following delivery, but a premature baby averages 20 outpatient visits

    Real-world tactics and strategic guidance health plans need to solve their current challenges and make smart investments for the future.

    Learn more about the Health Plan Advisory Council
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    Get 5 tips to improve your care management identification strategy.

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